Early vs Late Surgical Intervention for Morel-Lavallee Injuries: A Pacific Coast Surgical Association Prospective Multicenter Study

Background: MLLs are closed degloving injuries that occur throughout the body and present treatment challenges due to their rarity and variability in management. We aimed to compare characteristics and outcomes for Morel-Lavallée lesion (MLL) patients undergoing early (< 48-hours) versus late (>48-hours) surgical intervention, hypothesizing decreased length of stay (LOS) with early intervention. Study Design: 15 centers participated in this prospective observational study, including all adult patients who sustained a Morel-Lavallée lesion and underwent surgery. No patients were excluded. Bivariate comparisons for early vs late intervention cohorts were performed. Results: Of 150 MLL patients, 101 (67.3%) underwent early intervention. Both cohorts had comparable ages, body mass index, vitals, Charlson Comorbidity Index, and injury severity scores (all p>0.05). However, early intervention patients more commonly had abdominal (37% vs 6.3%, p<0.001) MLLs while late intervention patients more often had hip (16.7% vs 3.0%, p=0.01) and thigh (41.7% vs 22%, p=0.03) MLLs. Early patients had shorter intensive care unit (ICU) LOS (2 vs 5, p=0.003) but statistically similar hospital LOS (12 vs 20, p=0.06). There was no difference in wound-related complications (19.8% vs 24.5%, p=0.51) or mean number of additional surgeries (p=0.41) between cohorts. Conclusion: Over two-thirds of MLL patients underwent early operation. These patients had decreased ICU LOS and a statistically similar albeit clinically shorter overall LOS, despite similar demographics, comorbidities, injury severity, and number of additional surgeries. Therefore, early operation appears beneficial and should be pursued in MLL patients when clinically indicated and feasible.